Unveiling the role of physician implicit bias and communication behaviors in dissatisfaction, mistrust, and nonadherence in Black patients with Type 2 diabetes

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Patient-physician racial discordance is strongly associated with patient dissatisfaction and mistrust in physicians, which is further associated with poor treatment adherence and suboptimal healthcare utilization. This poses serious public health challenges because approximately 80-90% of Black patients see physicians from different racial groups. Patient dissatisfaction and mistrust have been recently found to be particularly magnified when physicians hold high levels of automatic, implicit bias toward Black Americans, suggesting that physicians’ implicit racial bias impacts physician communication behaviors during medical interactions and ultimately Black patient outcomes. The overall goal of this research is to identify physicians’ communication behaviors during medical interactions that are associated with physicians’ implicit racial bias and Black patients’ immediate (satisfaction, trust) as well as clinically important longer-term outcomes (adherence, healthcare utilization). To achieve this goal, we target medical interactions involving Black patients with Type 2 diabetes mellitus (T2DM) because nonadherence in Black patients with T2DM is particularly prevalent. Additionally, the patient-physician communication quality has been found to predict patient adherence to T2DM treatment regimens. We will use a mixed-methods design that integrates the strengths of inductive reasoning to explore which physicians’ communication behaviors during medical interactions matter from Black patients’ perspectives and deductive reasoning to identify theoretically and clinically important behaviors. Our aims are: Aim 1) to explore which physician communication behaviors during medical interactions are perceived negatively or positively by Black patients and why; Aim 2) to identify which physician communication behaviors identified in Aim 1 are associated with physicians’ implicit racial bias; and Aim 3) to examine how physicians’ implicit racial bias impacts Black patients’ satisfaction, trust, adherence, and healthcare utilization through physicians’ communication behaviors. We will use an innovative integration of multiple methods (interviews, video-recorded medical interactions, surveys, medical record reviews). Findings from this research will enable researchers to identify physician communication behaviors during medical interactions that are problematic and beneficial to the immediate and longer-term outcomes among Black patients with T2DM. Such an ability is needed to develop personally-tailored, targeted communication skills training and other interventions targeting patient-provider interactions to overcome racial disparities in diabetes treatment adherence, outcomes, and beyond. Additionally, upon completion of this project, we will have a Medical Interaction involving Black Patients Coding System (MIBPCS) that differs from prior patient-physician communication coding systems in that it: (1) will focus on physicians’ communication behaviors during medical interactions that can predict Black patients’ outcomes; and (2) places an unprecedented importance on the patients’ point of view.